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Boards GI

Stuff I should know

Barrett's esophagitis is caused by what? GERD
Barrett's esophagitis predisposes to what malignancy? Most common location? Adenocarcinoma; distal 1/3
Ranitidine- brand name, pharm class, use Zantac, H2 blocker, GERD
Zantac- generic name, pharm class, use Ranitidine, H2 blocker, GERD
Famotidine- brand name, pharm class, use Pepcid, H2 blocker, GERD
Pepcid- generic name, pharm class, use Famotidine, H2 blocker, GERD
TUMS- pharm class, use Antacid, Acid reflux/GERD
Alka Seltzer- pharm class, use Antacid, Acid reflux/GERD
Mylanta- pharm class, use Antacid, Acid reflux/GERD
Maalox- pharm class, use Antacid, Acid Reflux/GERD
Nexium- pharm class, use Esomeprazole, PPI, for moderate-severe GERD
Aciphex- pharm class, use Rabeprazole, PPI, for moderate-severe GERD
Prilosec- generic name, pharm class, use Omeprazole, PPI, for moderate-severe GERD
Omeprazole- brand name, pharm class, use Prilosec, PPI, for moderate-severe GERD
Prevacid- pharm class, use Lansoprazole, PPI, for moderate-severe GERD
Protonix- pharm class, use Pantoprazole, PPI, for moderate-severe GERD
Mechanism of action for H2 blockers in GERD Decrease production of stomach acid
Mechanism of action for PPIs in GERD Inhibit the H+/K+ ATPase = inhibits acid secretion
Common causes of infectious esophagitis (3) Candida, CMV, Herpes simplex
Symptoms of infectious esophagitis odynophagia/dysphagia in immunocompromised pt
Lab test for infectious esophagitis (immunocompromised pt + odynophagia/dysphagia) Endoscopy + cytology/culture
Cranial nerves involved in swallowing V, VII, IX, X, XI, XII
Cause: dysphagia with liquids and solids Neurogenic- injury/disease of brainstem or cranial nerves involved in swallowing (V, VII, IX, X, XI, XII)
Cause: regurgitation of undigested food and liquid several hours after eating Zenker's Diverticulum
Zenker's Diverticulum- description and symptoms outpouching of posterior hypopharynx causing regurgitation of undigested food and liquid several hours after eating
Cause: Slow progression of solid food dysphagia Esophageal stenosis
Cause: Slow progressive dysphagia with episodic regurgitation and chest pain Achalasia
Achalasia- description and symptoms Decreased peristalsis + increased lower esophageal sphincter tone = slow progressive dysphagia with episodic regurgitation and chest pain.
Cause: dysphagia + intermittent chest pain that may or may not be associated with eating. Esophageal spasm
Dysphagia lab test Barium swallow/pharyngoscopy/esophagoscopy
Most common types of esophageal malignancy (2) Squamous cell and adenocarcinoma
Most common location of esophageal adenocarcinoma? Distal 1/3 of esophagus
Most common location of esophageal squamous cell carcinoma? Proximal 2/3 of esophagus
Cause: rapid progression of dysphagia for solid food? Esophageal malignancy
Most likely diagnosis: vomiting + hematemesis Mallory Weiss tear
Esophageal varices- description and most common location Dilation of veins of esophagus, commonly at distal end
Esophageal varices- cause Portal hypertension/cirrhosis
Budd Chiari Syndrome- complications Portal vein thrombosis -> esophageal varices
Bleeding Esophageal varices- treatment Hemodynamic support- high volume fluid replacement + vasopressors + endoscopic therapy + pharm vasoconstriction
Common causes of gastritis/duodenitis (4)? Autoimmune/pernicious anemia, H.pylori, NSAIDS, alcohol
Treatment for H. pylori PPI + Amoxicillin (or metronidazole) + Clarithromycin x 14 days
Most likely diagnosis for nausea + feeling of excessive fullness after meals? Delayed gastric emptying
Treatment for delayed gastric emptying (pharm category + 2 examples)? Prokinetics: cisapride, metoclopramide
Cisapride- pharm class, use Prokinetic, for delayed gastric emptying
Metoclopramide- pharm class, use Prokinetic, for delayed gastric emptying
Most common location for PUD? Duodenal>gastric
Most likely diagnosis for burning/gnawing abdominal pain radiating to back that improves with food? Duodenal ulcer
Most likely diagnosis for burning/gnawing abdominal pain radiating to back that worsens with food? Gastric ulcer
Zollinger Ellison Syndrome- description Gastrin secreting tumor; gastrin stimulates H+ secretion and growth of gastric mucosa. Cause PUD.
Most common locations of gastrinomas in Zollinger Ellison Syndrome? Pancreas and duodenum
How to distinguish Zollinger-Ellison Syndrome from PUD? ZES may be refractory to treatment
Zollinger Ellison Syndrome labs (2) Fasting gastrin level, secretin test
Zollinger Ellison Syndrome treatment PPIs, surgical resection of gastrinoma when possible
What is Virchow's node? Left Supraclavicular lymphadenopathy
Symptoms of Gastric adenocarcinoma? Dyspepsia unresponsive to therapy, weight loss, anemia, occult GI bleeding, age >40.
Most common site for extra nodal non-Hodgkin's lymphoma? Stomach
Diarrhea definition 3+ liquid/semisolid stools daily x2-3 consecutive days
Infectious causes of watery diarrhea (6)? Norovirus, Rotavirus, Cryptosporidia, Cyclospora, Vibrio, Clostridium perfringens toxin
Organisms responsible for diarrhea from undercooked poultry (2)? Salmonella, Campylobacter
Infectious causes of bloody diarrhea (3)? E.coli, Shigella, Campylobacter
Inflammatory diarrhea symptoms bloody diarrhea + fever
Secretory diarrhea causes Pancreatic insufficiency, bacterial toxins, laxatives
Definition of normal bowel function Range of 3 stools/day to 3 stools/week.
Definition of constipation Decrease in stool volume, increase in stool firmness, and straining
Causes of constipation ignoring urge, decreased motility of colon (age, emotion, low bulk diet), obstruction (tumor, sprain), nerve injury, narcotics
Constipation conservative management Increase fiber (20-40g/day), increase fluid intake, exercise
Cause of small bowel obstruction (2) Adhesions or hernia
Most likely cause of large bowel obstruction Neoplasm. Others: strictures, hernias, volvulus, intussusception, fecal impaction
Definition of volvulus Twisting of bowel on itself
Common site of volvulus Sigmoid or cecal area
Physical exam finding of volvulus Tympany
Pt presents complaining of cramping abdominal pain, distention, nausea, vomiting, and obstipation. You suspect a volvulus. What imaging study should you do? Abdominal plain film- will show colonic distension
Treatment for volvulus Endoscopic decompression
Screening tests for Celiac disease IgA antiendomysial and antitissue transglutaminase antibodies
Confirmation test for Celiac disease Small bowel biopsy
Areas affected by Crohn's Disease The entire GI tract, except the rectum which is frequently spared(Small and large bowels, mouth, esophagus, stomach).
Characteristic finding of Crohn's Disease Skip lesions
Common presenting complaints of Crohn's Disease Abdominal cramps, diarrhea in patient <40, blood in stool, low-grade fever, anemia, polyarthralgia, fatigue
Laboratory test in Crohn's Disease Colonoscopy
Treatment for acute Crohn's attacks Oral corticosteroids
Maintenance therapy for Crohn's Disease Mesalamine- a bowel-specific anti-inflammatory (aminosalicylate)
Characteristic findings of Ulcerative Colitis Continuous disease (no skip lesions) starting distally at rectum and progresses proximally
Common symptoms of Ulcerative Colitis Bloody, pus-filled diarrhea and tenesmus
Tests to avoid with Ulcerative Colitis and why Colonoscopy + barium enema -> risk of perforation and toxic megacolon
Test for Ulcerative Colitis Sigmoidoscopy/Colonoscopy
Treatment for Ulcerative Colitis Topical or oral (Mesalamine) aminosalicylates (anti-inflammatory) and corticosteroids. Total proctocolectomy is curative.
Characteristic S&S of IBS Constipation, Diarrhea, or alternating Constipation and Diarrhea, dyspepsia, pain worse with food intake and relieved by defecating, most common in women.
Lab findings of IBS Normal
IBS treatment Avoid triggers, high fiber diet, bulking agents, symptomatic
Definition of Intussusception Invagination of a proximal segment of bowel into the portion just distal to it.
Characteristic of patient most likely to get intussusception Child following viral infection
Common cause of intussusception in adults Neoplasm
Clinical features of intussusception Colicky pain, mucus and blood in stool (currant jelly), sausage-like mass
Currant jelly stool/mucus + blood in stool is indicative of what condition? Intussusception
Lab test for intussusception Barium/air enema + hospitalization
Description of diverticulosis Large outpouching of mucosa in colon
How to prevent diverticulitis in diverticulosis? High fiber diet and avoid constipating foods
Diverticulitis S&S LLQ pain, +/- fever, altered BMs, nausea, vomiting
Lab tests in diverticulitis Fecal occult blood, plain film radiography
Diverticulitis treatment low residue diet, broad spectrum antibiotics, +/- hospitalization for IV abx, bowel rest and analgesics
Can a pt with diverticulitis eat nuts, seeds, popcorn, etc? Yes
Cause of ischemic bowel disease Cardiovascular/collagen vascular disease
Most common site of intestinal infarction (AMI- acute mesenteric ischemia) Small bowel
Most likely diagnosis for abdominal pain occurring 10-30 minutes after eating, relieved somewhat by squatting or lying down. Chronic mesenteric ischemia/ ischemic bowel
Most likely diagnosis for sudden onset of severe abdominal pain, out of proportion to exam findings... may develop involuntary guarding, rebound, and heme positive stool Acute mesenteric ischemia/ ischemic bowel
Diagnostic test for ischemic bowel Colonoscopy
Description of Hirschsprung's Disease Congenital aganglionosis of the colon
Description of toxic megacolon Extreme dilatation and immobility of the colon... an emergency
Causes of toxic megacolon in adults Ulcerative colitis, Crohn's, pseudomembranous colitis, infection (amebiasis, Shigella, Campylobacter, C.diff)
Cause of toxic megacolon in children Hirschsprung's disease
Symptoms of toxic megacolon Fever, prostration, severe cramps, abdominal distension, rigid abdomen, rebound tenderness
Diagnostic test for toxic megacolon Plain film radiography
Treatment for toxic megacolon Decompression of colon
Symptoms if colonic polyps (if any... usually asymptomatic) Constipation, flatulence, rectal bleeding
When should screening start for a pt with a history of familial polyposis and how often should they be screened? Start at age 10-12 q1-2 years
Clinical features of colon cancer Slow growing; abdominal pain, long-term change in bowel habits, occult bleeding, intestinal obstruction
When should screening begin for colon cancer and how often? Start at age 50 q5-10 years
Anorectal abscess is a result of what? Infection
Why does an anorectal fistula form? As a complication of chronic abscess
S&S of anorectal abscess Painful swelling at anus and painful defecation, localized tenderness, erythema, swelling, and fluctuance... fever in deeper abscesses
S&S of anal fissure Severe tearing pain on defecation, hematochezia, bright red blood on toilet paper
Anal fissure treatment Bulking agents, increased fluid, sitz bath for acute pain, topical nitroglycerin
Rating category of hemorrhoid that is visible perianally External hemorrhoid
Rating category of hemorrhoid that is confined to anal canal and may bleed with defecation Stage I hemorrhoid
Rating category of hemorrhoid that protrudes from anal opening and reduces spontaneously. Bleeding and mucoid discharge may occur. Stage II hemorrhoid
Rating category of hemorrhoid that requires manual reduction after BM.Pt may have pain and discomfort Stage III hemorrhoid
Rating category of hemorrhoid that is chronically protruding and risks strangulation Stage IV hemorrhoid
Treatment of Stage IV hemorrhoid Surgery- injection, rubber band ligation, sclerotherapy
Treatment of Stage III hemorrhoid and initial Stage IV hemorrhoid Suppositories with anesthetic and astringent
Treatment of Stage I and II hemorrhoids High fiber diet, increased fluids, bulk laxatives
Most common cause of appendicitis? Fecalith
McBurney's point 1/3 distance from anterior superior iliac spine to umbilicus, where pain localizes in appendicitis
Psoas sign-describe Patient is supine and attempts to raise R leg against resistance- causes pain in appendicitis
Obturator sign- describe Patient is supine and attempts to flex and internally rotate the R hip with the knee bent- causes pain in appendicitis
Lab findings in appendicitis Leukocytosis (10,000-20,000 cells/mL), CT to confirm
Most common causes of pancreatitis (2)? Cholelithiasis, alcohol abuse
Causes of pancreatitis other than cholelithiasis and alcohol abuse (6)? Scorpion sting, hyperlipidemia, trauma, drugs, hypercalcemia, penetrating PUD
S&S of pancreatitis? Epigastric pain radiating to back, lessens when leans forward or in fetal position, nausea and vomiting
What is the most sensitive and specific test for pancreatitis? Lipase
Labs for pancreatitis? Lipase, amylase, CBC- WBC, liver enzymes (Increased if biliary obstruction)
Ranson's criteria used to predict prognosis of what condition? Pancreatitis
What 8 factors does Ranson's criteria use for prognosis of pancreatitis? WBC count, blood glucose, lactate dehydrogenase, AST, arterial PO2, Base deficit, Calcium, BUN
Treatment for acute pancreatitis? NPO, maintain fluids, parenteral nutrition, Meperidine for pain, +/- abx
Most common cause of chronic pancreatitis? Alcohol abuse
Classic triad of chronic pancreatitis- what is it and how often does it occur? Pancreatic calcification, steatorrhea, DM. Occurs in 20% of patients.
Diagnostic study for chronic pancreatitis? Abdominal plain film radiography- shows calcification
Treatment for chronic pancreatitis? D/C alcohol, low fat diet, surgical removal of part of pancreas for pain control
Describe Courvoisier's sign Palpable gallbladder- may indicate pancreatic cancer
What are the S&S of pancreatic cancer? Andominal pain +/- radiation, jaundice, Courvoisier's sign
Treatment for pancreatic cancer? Whipple's procedure (surgical resection)
Diagnostic study for pancreatic cancer? CT and angiography
Describe Murphy's sign. Palpate liver/gallbladder during inhalation and pt stops breathing
Should an asymptomatic patient with choledocholithiasis be treated? No
Complications of choledocholithiasis (3)? Cholecystitis, pancreatitis, acute cholangitis
Labs for choledocholithiasis? Liver tests: AST, ALT, serum bilirubin, alkaline phosphatase, GGT. TRANSABDOMINAL ULTRASOUND.
Cause of acute cholecystitis? Obstruction of bile duct- stone
S&S of acute cholecystitis? Colicky epigastric or RUQ pain after a high fat meal, may radiate to R shoulder/subscapula, nausea, vomiting, low grade fever
Labs of acute cholecystitis? HIDA scan, ^ serum and urine bilirubin, ^WBC
Treatment of acute cholecystitis? Surgery
Common infectious causes of acute cholangitis (4)? E.coli, Enterococcus, Klebsiella, Enterobacter
Most common cause of acute cholangitis? Choledocholithiasis
What are the features of Charcot's Triad and what condition are the typically positive in? RUQ tenderness, jaundice, fever... present in acute cholangitis
What are the features of Reynold's Pentad? Charcot's Triad (RUQ pain, jaundice, fever) + altered mental status + hypotension... indicates sepsis in acute cholangitis. Disease can become rapidly fatal
Labs in acute cholangitis ERCP is optimal, RUQ ultrasound is good initial test. ^WBC, ^bilirubin, ^transaminase
Treatment for acute cholangitis? ABX (Fluoroquinolone+Ampicillin+Gentamycin +/- Metronidazole, ERCP + stent placement
Most common features of primary sclerosing cholangitis (2)? Jaundice + pruritis
S&S of primary sclerosing cholangitis? Jaundice, pruritis, fatigue, malaise, weight loss, hepatomegaly/splenomegaly
Conservative treatment for primary sclerosing cholangitis Ursodiol (a bile acid that decreases liver enzymes) + endoscopic management of stricture
Definitive management of primary sclerosing cholangitis? Liver transplant
What is the most common cause of hepatitis? Viral
What is the second most common cause of hepatitis? Alcohol
Which viral strains cause chronic hepatitis? B,C,D
What is Wilson's Disease? Inherited disorder resulting in accumulation of copper in the tissues, especially liver and brain.
What is a unique clinical presentation of Wilson's Disease? Kayser-Fleischer rings- yellow/brown rings around edge of iris from copper deposition
Gold standard for diagnosis Wilson's Disease? Liver biopsy
Treatment for Wilson's Disease? Pencillamine- chelates the copper
What are 2 inherited disorders that can cause hepatitis? Wilson's Disease and Alpha-1 antitrypsin deficiency
Which Hepatitis viral strains are transmitted by fecal-oral route? A and E
Describe the Rule of 20's for Hepatitis 20% of those infected will clear virus, 20% who develop chronic disease will develop cirrhosis in 20 years, 20% will develop hepatocellular CA
Hepatitis D is seen only in conjunction with which other viral hepatitis? Hepatitis B
Hepatitis B and C are frequently coinfected with what other STD? HIV
S&S of Hepatitis? Fatigue, malaise, anorexia, nausea, tea colored urine, and abdominal discomfort, scleral icterus, jaundice
Lab interpretation: Anti-HAV Active disease
Lab interpretation: HAV IgG Resolved Hepatitis A
Lab interpretation: HBsAg Ongoing Hepatitis B infection
Lab interpretation: anti-HBs Hepatitis B immunity by past infection or vaccination
Lab interpretation: anti-HBc Acute hepatitis; it is present between HBsAg and anti-HBs
Lab interpretation: HBeAg Highly contagious active infection
Lab interpretation: anti-HBe Active infection, lower viral titer = not as contagious
Treatment of acute hepatitis Supportive
Treatment of chronic hepatitis B Tenofovir + Emtricitabine/Lamivudine for HepB + Efavirenz for HIV.
Pt's with Hepatitis B should also be treated for what infection? HIV, regardless of CD4 count
Patients with Hepatitis C should be vaccinated against what other forms of Hepatitis? A and B
Vaccines are available for what forms of hepatitis? A and B
Causes of toxic hepatitis (4)? Alcohol, acetaminophen, isoniazid, phenytoin (among others)
What drug can be used for acetaminophen toxicity? Acetylcysteine
What is the most common cause of cirrhosis? Alcohol
Late stage S&S of cirrhosis? Ascites, pleural effusions, peripheral edema, ecchymoses, esophageal varices, hepatic encephalopathy signs: asterixis, tremor, dysarthria, delirium, coma eventually
Labs in cirrhosis Minimally abnormal until late dz. Mild^ in AST and alk phos, decreased albumin. U/S, CT or MRI
Cirrhosis treatment D/C alcohol, if ascites: salt restriction and bed rest vs. spironolactone. Liver transplant.
Benign or malignant: hepatic cavernous hemangioma Benign
Benign or malignant: hepatocellular adenoma Benign
Benign or malignant: infantile hepatic hemangioendothelioma Benign
Common site of metastasis for breast and lung cancer? Liver
Labs for hepatocellular carcinoma ^alpha fetoprotein, CT/MRI/hepatic angiography
Treatment for hepatic carcinoma Surgical resection if confined to one lobe, liver transplant in some
Umbilical hernia often occurs when? Birth
Treatment of umbilical hernia? Surgery if indicated but most resolve on own
Describe a hiatal hernia Protrusion of stomach through diaphragm...causes GERD
Treatment of hiatal hernia? Acid reduction vs. surgery
Incisional hernias often occur with what type of incision? Vertical
What are the 3 types of inguinal hernias? Direct, Indirect, and Femoral
Describe an indirect inguinal hernia Passage of intestine through internal inguinal ring down inguinal canal; may pass into scrotum
What is the most common type of inguinal hernia? Indirect
Which type of inguinal hernia commonly passes into the scrotum? Indirect
Describe a direct inguinal hernia Passage of intestine through external inguinal ring at Hesselbach's triangle
What is the least common type of inguinal hernia? Femoral
Describe femoral hernia Passage of intestine through femoral ring
Describe ventral hernias Weakening of anterior abdominal wall via incision or umbilical allows passage of intestine
Hernia treatment Surgery
Most likely diagnosis for newborn with excessive saliva, choking/coughing with feeding Esophageal atresia
Diagnostic "test" for esophageal atresia Inability to pass nasogastric tube
Treatment for esophageal atresia Surgery + NPO to prevent aspiration
Most likely diagnosis for newborn with new onset respiratory distress and bowel sounds heard in chest Diaphragmatic hernia
Describe diaphragmatic hernia Hernia through the diaphragm in newborns compresses a lung, causing respiratory distress and bowel sounds able to be heard in the chest
Treatment for diaphragmatic hernia Immediate intubation an ventilation, suction stomach via NG tube, surgery
Most likely diagnosis in an infant 4-6 weeks old who projectile vomits after feedings, but always seems hungry. Mom complains of weight loss and baby is dehydrated Pyloric stenosis
Physical exam finding in infant with pyloric stenosis? Olive-shaped mass to right of umbilicus
Diagnostic test for pyloric stenosis U/S; "string sign"
Most common site of bowel atresia? Ileum
Most likely diagnosis for infant presenting with signs of bowel obstruction within first few days of life? Bowel atresia
Describe Hirschsprung's Disease Congenital megacolon caused by absence of bowel innervation (by Meissner's and Auerbach's autonomic plexuses)
S&S of Hirschsprung's Disease Constipation/obstipation, vomiting, failure to thrive in infant
Hirschsprung's Disease treatment Surgical resection of affected bowel
Night blindness warrants suspicion of what vitamin deficiency? Vitamin A
Rickets warrants suspicion of what vitamin deficiency? Vitamin D
Bleeding warrants suspicion of what vitamin deficiency? Vitamin K
Beri Beri (nerve tingling, poor coordination, edema, weakness, and cardiac dysfunction) warrants suspicion of what vitamin deficiency? Thiamin
Oral inflammation + eye disorders warrants suspicion of what vitamin deficiency? Riboflavin
"Flushing" warrants suspicion of what vitamin deficiency? Niacin
Tingling + Fatigue + Headache warrants suspicion of what vitamin deficiency? Pantothenic Acid
Headache + Anemia + Seizures + Flaky skin + sore tongue warrants suspicion of what vitamin deficiency? B6
Megaloblastic anemia + sore tongue + diarrhea + mental disorders warrants suspicion of what vitamin deficiency? Folate
Megaloblastic anemia + poor nerve function warrants suspicion of what vitamin deficiency? B12
Scurvy (poor wound healing, petechiae, bleeding gums) warrants suspicion of what vitamin deficiency? Vitamin C
Functions of Vitamin A (4)? Vision, epithelial cell maturity, resistance to infection, antioxidant
Toxicity of what vitamin can inhibit the function of Vitamin K? Vitamin E
Functions of Vitmain D (2)? Calcium regulation, cell differentiation
Functions of Vitamin E (3)? Slow cell aging, vascular wall integrity, antioxidant
Function of Vitamin K (1)? Clotting
Functions of Thiamin (2)? Carbohydrate metabolism, nerve function
Function of Riboflavin (1)? Energy
Functions of Niacin (2)? Energy, fat metabolism
Functions of Pantothenic Acid (2)? Energy, fat metabolism
Functions of Vitamin B6 (3)? Protein metabolism, neurotransmitter synthesis, hemoglobin
Function of Folate (1)? DNA synthesis
Functions of Vitamin B12 (2)? Folate metabolism, nerve function
Folate needs what other vitamin for its metabolism? Vitamin B12
Functions of Vitamin C (3)? Collagen synthesis, hormone function, neurotransmitter synthesis
Describe Phenylketonuria Autosomal recessive disorder resulting in inability to metabolize the protein phenylalanine, which, when accumulated, results in mental retardation and movement disorders
Most likely diagnosis for middle-aged woman presenting with cholestatic liver enzyme levels. She does not take any meds, does not drink alcohol, and does not complain of abdominal pain. No previous biliary tract surgeries. Primary biliary cirrhosis
Risk Factor for non-healing duodenal ulcer? a)age >50 b)high fat diet c)cigarette smoking d)chronic stress e)alcohol use C) cigarette smoking
Before treating a Hepatitis C patient with interferon, you must first ensure they do not have this type of disease, as interferon is contraindicated with it. Autoimmune diseases
Describe the S&S of primary biliary cirrhosis Common in women between ages 40-60, often found incidentally with elevated alkaline phosphatase level as it is often asymptomatic.
Patients with HIV may be affected by chronic diarrhea caused by what organism? (Pt's found to have this organism with chronic diarrhea should always be checked for HIV) Cryptosporidium
Which strain of hepatitis is most likely to become chronic hepatitis? Hepatitis C
Should a pregnant woman with Hepatitis C be concerned about transmitting the virus to her baby? No, risk of transmission is low
What is the most common malignant tumor of the esophagus in the African American male population? Squamous cell carcinoma
In Western society, diverticulosis most often occurs in what part of the colon? Sigmoid
Routine colonoscopy on a patient with no other risk factors should be performed how often as of age 50? Every 10 years
Treatment for Giardia lamblia? Metronidazole
Describe Markle sign/Jar sign Patient is asked to stand on toes, then drop quickly to heels. Pain location upon hitting the floor should be noted, and indicates peritoneal irritation
Blumberg sign is also known as what? Rebound tenderness
Pellagra consists of what triad? Dermatitis, Diarrhea, and Dementia
Pellagra is caused by deficiency of what vitamin? Niacin
Most common causes (2) of niacin deficiency in the US? Alcoholism or malabsorption
Describe signs and significance of Cullen sign A faint blue coloration (superficial edema and bruising) around the umbilicus, indicates retroperitoneal bleeding
Dermatitis herpetiformis, a pruritis paplovesicular rash on extensor surfaces of arms and legs, trunk and neck is likely to have what GI condition? Celiac Disease
Describe the S&S of Whipple Disease Seronegative arthritis, fever, lymphadenopathy, weight loss, malabsorption, and diarrhea occurring in 4th-6th decades of life.
Treatment for antibiotic-associated colitis Oral metronidazole> IV Vancomycin
B12 requires what for adequate absorption from the stomach? Intrinsic factor
Best initial diagnostic test for suspected perforated peptic ulcer Upright/Decubitus abdominal plain film
Most common cause of traveler's diarrhea in adults (3) E.coli, Shigella, and C.jejuni
Most common cause of acute gastroenteritis in children Rotavirus
Initial treatment for mild-moderate ulcerative pancolitis 5-ASA products (sulfasalazine or mesalamine)
Describe Meckel's diverticulum Congenital outpouching of distal ileum that often presents by age 2 with painless rectal bleeding or symptoms similar to appendicitis (epigastric/umbilical pain)
An ICU patient with sepsis who is being mechanically ventilated due to respiratory failure is at increased risk of what GI complication? Stress ulcer
A diet high in nitrates significantly increases risk for cancer of which organ? Stomach
Lab test to confirm diagnosis of Giardia lamblia Stool sample for ova and parasites
Lab test for hepatic encephalopathy-induced mental status changes (confusion/lethargy) Serum ammonia
Describe Gilbert syndrome Hereditary; reduced activity of the enzyme glucuronyltransferase (conjugates bilirubin), therefore causing high levels of unconjugated bilirubin in the bloodstream. Sx: jaundice, fatigue and other vague symptoms
Describe conjugated vs. unconjugated bilirubin Bilirubin comes from heme of old RBCs broken down by the spleen. It is transported to liver bound to albumin, where it is conjugated with glucuronic acid by glucuronyltransferase, making it H20 soluble and secreted in bile
Cause of conjugated/direct bilirubinemia? Impaired bilirubin excretion from liver due to hepatocellular disease (hepatitis, cholelithiasis, sclerosing cholangitis, cancer)
Most common hernia in men? Femoral
Most common population to exhibit obturator hernias? Elderly women
Where will direct and indirect hernias be palpated? Above the inguinal ligament
Where will femoral hernias be palpated? Below the inguinal ligament
Most cases of thiamine deficiency in the US are caused by what condition? Alcoholism
Created by: mccullough87